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Oregon Department of Environmental Quality <br /> DID NOT PERFORM SEPTIC TANK EVALUATION AT THIS TIME. <br /> * The septic tank material is: <br /> Concrete <br /> Steel <br /> Plastic <br /> Fiberglass <br /> Other(explain) <br /> Unknown <br /> * Is the septic tank accessible? Yes No <br /> * Septic tank volume in gallons <br /> * Tank volume determined by:Check all that apply,add comments below as needed <br /> Permit Records Measured Stamped on Tank Other <br /> * Septic tank risers are at ground level Yes No <br /> * Tank appears to be free from defects,leaking and signs of deterioration Yes No <br /> If you answered"No," please describe the condition of the septic tank below. For example, <br /> evidence of gas corrosion,cracks,leaks,etc. <br /> * Septic tank lid(s)is intact Yes No <br /> * Septic tank baffles are intact: Inlet Yes No Outlet Yes No <br /> * Baffle material-Inlet Plastic Concrete Metal <br /> Outlet Plastic Concrete Metal <br /> * Effluent filter is present Yes No <br /> * Effluent filter is free of debris Yes No Not applicable <br /> * Liquid level in tank relative to invert of outlet At Above Below <br /> If above or below invert outlet,please explain: <br /> * Scum layer (inches) Sludge layer_(inches) <br /> * Scum and Sludge layer more than 35%of the total tank volume Yes No <br /> Indicate where sludge measured from: Inlet Middle Outlet <br /> * Additional comments: <br /> 4. Dosing tank/Pump Basin <br /> Dosing tanks use a pump to send effluent to a treatment unit or soil absorption field. <br /> * The septic system has a dosing tank Yes No <br /> (If"No,"skip the rest of section 4) <br /> * At the time of this evaluation the power was on to test the pump(s): Yes No <br /> Page 3 of 8 <br />